Nokea
A client is hospitalized with oat cell carcinoma of the lung. To manage severe pain, the physician prescribes a continuous I.V. infusion of morphine. Which formula should the nurse use to check that the morphine dose is appropriate for the client?
- A. 1 mg/kg of body weight
- B. 5 mg/70kg of body weight
- C. 5 mg/kg of body weight
- D. 10mg/70kg of body weight
Correct Answer: C
Rationale: When calculating the appropriate dose of morphine for a client, the nurse should consider the client's body weight. The most commonly used formula for calculating the appropriate dose of morphine is 0.1 to 0.2 mg/kg of body weight for hourly dosing or 2.5 to 10 mg/kg/day for continuous infusions.
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A 16-year-old mother complaining she feels unhappy living with her husband and his family. The most appropriate action is
- A. refer her to an obstetrician
- B. explain the way of milk expression
- C. apply Edinburgh postnatal depression scale
- D. advise her on milk engorgement
Correct Answer: C
Rationale: The Edinburgh Postnatal Depression Scale is a screening tool for postnatal depression which might address her unhappiness.
Which of the following symptoms is a classic sign of systemic lupus erythematosus (SLE)?
- A. Superficial lesions over the cheek and
- B. Weight loss nose
- C. Difficulty urinating
Correct Answer: A
Rationale: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect various organs in the body. One of the classic signs of SLE is the presence of a facial rash in the shape of a butterfly over the cheeks and bridge of the nose. This rash is known as a malar rash and is often one of the first visible symptoms of the disease. Weight loss and difficulty urinating are not typical signs of SLE.
During examination of a toddler's extremities, the nurse notes that the child is bowlegged. What should the nurse recognize regarding this finding?
- A. Abnormal and requires further investigation
- B. Abnormal unless it occurs in conjunction with knock-knee
- C. Normal if the condition is unilateral or asymmetric
- D. Normal because the lower back and leg muscles are not yet well developed
Correct Answer: A
Rationale: Bowlegged appearance in a toddler is not considered normal and should prompt further investigation by a healthcare provider. Bowlegs, also known as genu varum, can be caused by various underlying conditions such as vitamin D deficiency, rickets, or genetic factors. It is important to determine the cause of bowleggedness in order to provide appropriate treatment or interventions to promote proper development of the child's legs. Bowleggedness on its own is not considered a normal variation in toddler development and warrants further assessment.
Granulocytic sarcoma masses are commonly seen in which type of the following malignancies?
- A. neuroblastoma
- B. rhabdomyosarcoma
- C. soft tissue sarcoma
- D. AML
Correct Answer: D
Rationale: Granulocytic sarcoma is most commonly associated with acute myeloid leukemia (AML).
An adult has a central line in his right subclavian vein. The nurse is to change the tubing. Which of the following should be done?
- A. Use the present solution with the new tubing
- B. Connect the new tubing to the hub prior to running any fluid through the tubing
- C. Close the roller clamp on the new tubing after priming it
- D. Have the client roll to the right side to prevent an air embolus
Correct Answer: C
Rationale: The correct action to be taken when changing the tubing of a central line in the right subclavian vein is to close the roller clamp on the new tubing after priming it. This step is important to prevent air from entering the central line, which can lead to an air embolus. Proper priming and ensuring that the tubing is connected securely are essential steps in maintaining the integrity and safety of the central line system. Therefore, closing the roller clamp after priming the new tubing is crucial to prevent complications.